Fraud Blocker

Consent to Release Information Form

Instruction: To fill out the Consent to Release Information form, simply provide your name, email, and date of birth. You’ll also need to include the contact details of the person or organization you want to receive your substance abuse evaluation report. This can be a fax number, email address, or mailing address. After you submit the form, we’ll send the report using the method you choose: fax, email, or mail.
Note: Please allow up to 24 business hours for requests to release information to be processed.